Officials from the United Nations and elsewhere have said that a timely response averted a famine.
But research led by a scientist at the U.S. government's Centers for Disease Control and Prevention and funded by the United Nations Children's Fund suggests that officials vastly underestimated the emergency.
The conclusions are based on a survey of the hard-hit Gode region in southeastern Ethiopia by CDC medical epidemiologist Peter Salama and colleagues from Save the Children USA and UNICEF. Results appear in Wednesday's Journal of the American Medical Association.
The report follows a July warning from the World Food Program, the U.N.'s emergency food aid division, that drought conditions persist in some parts of Ethiopia and that donations are badly needed to avert serious problems in already vulnerable populations.
According to Salama's study, "a prolonged and severe famine" occurred in Gode from December 1999 or earlier until at least July 2000.
In Salama's survey of households comprising 4,032 Gode residents, there were 293 deaths during the period, more than half of them in children under 5 years old.
By extrapolation, Salama estimated that about 19,900 deaths occurred in Gode and about 78,000 in four other hard-hit regions.
"Most deaths were due to wasting and major communicable diseases" and 77 percent occurred before the humanitarian intervention began in April-May 2000, the researchers said.
The "delayed and inadequate" response involved setting up food programs in a few central locations rather than broader disbursement. That exposed malnourished people from remote regions to crowds and to diseases such as measles that ultimately killed many of them, the JAMA report says.
"Less centralized, community-based programs for selective feeding need to be considered" in the future, the authors said.
Despite an ongoing measles epidemic from December 1999 through July 2000, a strong measles vaccination campaign wasn't implemented in Gode until August 2000 and thus failed to prevent many illnesses and deaths, the report said.
The authors say changes such as broader, more quickly implemented vaccination programs are needed to avert large-scale loss of life in similar situations.
World Food Program spokeswoman Abby Spring defended the agency's actions.
"The UN rang the hunger alarm bell early enough for the prevention of a repeat of the famine which killed over 1 million in Ethiopia in the mid-1980s," Spring said.
The World Food Program provided food to 7 million people in Ethiopia, including 2.5 million in the Somali region, where Gode is located, she said.
Spring said the exact death toll last year is unknown, but did not reach famine levels.
She said the JAMA report failto take into account aid workers' lack of access to vulnerable people in the troubled region a common problem in needy nations such as Ethiopia that are plagued by civil unrest.
"No one's saying that it wasn't hell for some people there," Spring said. "But we were trying to deliver food and people were shooting.
"We did the best we could with what we had," she said.
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